Sen. Mattie Hunter

Filed: 4/20/2018





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2    AMENDMENT NO. ______. Amend Senate Bill 3116 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Nurse Practice Act is amended by changing
5Section 65-35 as follows:
6    (225 ILCS 65/65-35)   (was 225 ILCS 65/15-15)
7    (Section scheduled to be repealed on January 1, 2028)
8    Sec. 65-35. Written collaborative agreements.
9    (a) A written collaborative agreement is required for all
10advanced practice registered nurses engaged in clinical
11practice prior to meeting the requirements of Section 65-43,
12except for advanced practice registered nurses who are
13privileged to practice in a hospital, hospital affiliate, or
14ambulatory surgical treatment center.
15    (a-5) If an advanced practice registered nurse engages in
16clinical practice outside of a hospital, hospital affiliate, or



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1ambulatory surgical treatment center in which he or she is
2privileged to practice, the advanced practice registered nurse
3must have a written collaborative agreement, except as set
4forth in Section 65-43.
5    (b) A written collaborative agreement shall describe the
6relationship of the advanced practice registered nurse with the
7collaborating physician and shall describe the categories of
8care, treatment, or procedures to be provided by the advanced
9practice registered nurse. A collaborative agreement with a
10podiatric physician must be in accordance with subsection (c-5)
11or (c-15) of this Section. A collaborative agreement with a
12dentist must be in accordance with subsection (c-10) of this
13Section. A collaborative agreement with a podiatric physician
14must be in accordance with subsection (c-5) of this Section.
15Collaboration does not require an employment relationship
16between the collaborating physician and the advanced practice
17registered nurse.
18    The collaborative relationship under an agreement shall
19not be construed to require the personal presence of a
20collaborating physician at the place where services are
21rendered. Methods of communication shall be available for
22consultation with the collaborating physician in person or by
23telecommunications or electronic communications as set forth
24in the written agreement.
25    (b-5) Absent an employment relationship, a written
26collaborative agreement may not (1) restrict the categories of



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1patients of an advanced practice registered nurse within the
2scope of the advanced practice registered nurses training and
3experience, (2) limit third party payors or government health
4programs, such as the medical assistance program or Medicare
5with which the advanced practice registered nurse contracts, or
6(3) limit the geographic area or practice location of the
7advanced practice registered nurse in this State.
8    (c) In the case of anesthesia services provided by a
9certified registered nurse anesthetist, an anesthesiologist, a
10physician, a dentist, or a podiatric physician must participate
11through discussion of and agreement with the anesthesia plan
12and remain physically present and available on the premises
13during the delivery of anesthesia services for diagnosis,
14consultation, and treatment of emergency medical conditions.
15    (c-5) A certified registered nurse anesthetist, who
16provides anesthesia services outside of a hospital or
17ambulatory surgical treatment center shall enter into a written
18collaborative agreement with an anesthesiologist or the
19physician licensed to practice medicine in all its branches or
20the podiatric physician performing the procedure. Outside of a
21hospital or ambulatory surgical treatment center, the
22certified registered nurse anesthetist may provide only those
23services that the collaborating podiatric physician is
24authorized to provide pursuant to the Podiatric Medical
25Practice Act of 1987 and rules adopted thereunder. A certified
26registered nurse anesthetist may select, order, and administer



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1medication, including controlled substances, and apply
2appropriate medical devices for delivery of anesthesia
3services under the anesthesia plan agreed with by the
4anesthesiologist or the operating physician or operating
5podiatric physician.
6    (c-10) A certified registered nurse anesthetist who
7provides anesthesia services in a dental office shall enter
8into a written collaborative agreement with an
9anesthesiologist or the physician licensed to practice
10medicine in all its branches or the operating dentist
11performing the procedure. The agreement shall describe the
12working relationship of the certified registered nurse
13anesthetist and dentist and shall authorize the categories of
14care, treatment, or procedures to be performed by the certified
15registered nurse anesthetist. In a collaborating dentist's
16office, the certified registered nurse anesthetist may only
17provide those services that the operating dentist with the
18appropriate permit is authorized to provide pursuant to the
19Illinois Dental Practice Act and rules adopted thereunder. For
20anesthesia services, an anesthesiologist, physician, or
21operating dentist shall participate through discussion of and
22agreement with the anesthesia plan and shall remain physically
23present and be available on the premises during the delivery of
24anesthesia services for diagnosis, consultation, and treatment
25of emergency medical conditions. A certified registered nurse
26anesthetist may select, order, and administer medication,



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1including controlled substances, and apply appropriate medical
2devices for delivery of anesthesia services under the
3anesthesia plan agreed with by the operating dentist.
4    (c-15) An advanced practice registered nurse who had a
5written collaborative agreement with a podiatric physician
6immediately before the effective date of Public Act 100-513 may
7continue in that collaborative relationship or enter into a new
8written collaborative relationship with a podiatric physician
9under the requirements of this Section and Section 65-40, as
10those Sections existed immediately before the amendment of
11those Sections by Public Act 100-513 with regard to a written
12collaborative agreement between an advanced practice
13registered nurse and a podiatric physician, until the
14collaborative relationship between the advanced practice
15registered nurse and podiatric physician terminates.
16    (d) A copy of the signed, written collaborative agreement
17must be available to the Department upon request from both the
18advanced practice registered nurse and the collaborating
19physician, dentist, or podiatric physician.
20    (e) Nothing in this Act shall be construed to limit the
21delegation of tasks or duties by a physician to a licensed
22practical nurse, a registered professional nurse, or other
23persons in accordance with Section 54.2 of the Medical Practice
24Act of 1987. Nothing in this Act shall be construed to limit
25the method of delegation that may be authorized by any means,
26including, but not limited to, oral, written, electronic,



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1standing orders, protocols, guidelines, or verbal orders.
2    (e-5) Nothing in this Act shall be construed to authorize
3an advanced practice registered nurse to provide health care
4services required by law or rule to be performed by a
5physician, including those acts to be performed by a physician
6in Section 3.1 of the Illinois Abortion Law of 1975.
7    (f) An advanced practice registered nurse shall inform each
8collaborating physician, dentist, or podiatric physician of
9all collaborative agreements he or she has signed and provide a
10copy of these to any collaborating physician, dentist, or
11podiatric physician upon request.
12    (g) (Blank).
13(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18;
14100-577, eff. 1-26-18.)
15    Section 99. Effective date. This Act takes effect January
161, 2018.".